New Institute for Health Equity Research Studies Issues Spotlighted by COVID-19

May 21, 2020 | COVID-19, Diversity and Inclusion, Featured, Public Health, Research

Co-Director Lynne Richardson, MD, left, and Director Carol Horowitz, MD, MPH, are guiding the new Institute for Health Equity Research. View an interview with Dr. Richardson on racial disparities and COVID-19.

The Mount Sinai Health System’s new Institute for Health Equity Research is quickly acting on its mandate to rigorously study disparities in health issues, including COVID-19, with the intention of translating those discoveries into initiatives and policies that benefit communities in New York and the nation.

“Our extensive expertise in population health and serving one of the most socioeconomically, demographically, and culturally varied populations in the world makes us uniquely positioned to take on this enormous challenge,” says Dennis S. Charney, MD, the Anne and Joel Ehrenkranz Dean of the Icahn School of Medicine at Mount Sinai, and President for Academic Affairs of the Mount Sinai Health System.

The COVID-19 pandemic is shining a light on long-existing health inequities, according to the Institute’s Director, Carol Horowitz, MD, MPH, Professor of Population Health Science and Policy, and Medicine, and Dean for Gender Equity in Science, and its Co-Director, Lynne D. Richardson, MD, Professor and Vice Chair of Emergency Medicine, and Professor of Population Health Science and Policy.

“Who gets COVID-19, who lives and who dies, maps very well, unfortunately, with other kinds of maps we have in New York City,” Dr. Horowitz says. “This includes areas of poverty, areas of majority of low-income, Latinx, and African American people, areas of more pollution, areas of more linguistic isolation, areas that have had more redlining in the past and other structural inequities. If you look at any map of New York City, and where people are marginalized, don’t have equal opportunities, and have higher burdens of chronic diseases, these are the same areas where COVID-19 seems to be hitting the most.”

Initiatives in Progress

The Institute has a variety of initiatives in progress, including Speak Up on COVID-19, a survey that was just launched in partnership with more than 100 New York City community organizations. “Speak Up” will be available in 11 languages to anyone with access to a smartphone. It is seeking to enroll more than 10,000 participants and will explore medical, demographic, social determinants, and COVID-19-related attitudinal, behavioral, and psychological factors; and try to identify participants’ needs and risk-factors. The survey also offers a resource guide, Dr. Horowitz says, answering questions such as “What are the resources for food? What are the resources if you are a survivor of domestic violence, and you can’t get out of your house? What do you do if you are homeless? What do you do to help your kids learn? What do you do if you are pregnant and you have COVID-19?”

And studies are underway on subjects including:

  • The impact of gender-affirming hormone treatment on the clinical course of COVID-19 in transgender and gender-nonbinary patients;
  • Health outcomes for those living with HIV and COVID-19;
  • How patient care via telehealth can be delivered equitably and narrow the digital divide.

The New York City Department of Health reports that 81 percent of COVID-19 cases are in the Bronx, Brooklyn, and Queens, with higher numbers in neighborhoods that are lower income and have more underserved residents. Only 12 percent of cases are in Manhattan, and there are signs of health disparity there as well, “right in our area, since The Mount Sinai Hospital is at the border of East Harlem and the Upper East Side,” Dr. Horowitz says. The DOH reports that as of May 18, in the 10029 zip code—East Harlem—there were 1,698 COVID-19 cases and 182 deaths, in a population that is 84 percent African-American and Latino with a median yearly income of $34,000.  The toll was markedly lower in the adjacent 10028 zip code—the Upper East Side—where there were 603 cases of COVID-19 and 34 deaths, in a population that is 71 percent non-Hispanic white with a median income of $114,000.

The Mount Sinai Health System is well positioned to collect and study its own data on health care disparity because of years of groundwork led by the Office for Diversity and Inclusion, says Gary C. Butts, MD, Chief Diversity and Inclusion Officer, Mount Sinai Health System, and Dean for Diversity Programs, Policy, and Community Affairs, Icahn School of Medicine. “Understanding disproportionality is important,” Dr. Butts says. “With the data we have assembled, we can study it better, and we can be positioned to close the gaps that we have been talking about for a long time. It’s the right thing to do, and it’s the smart thing to do.”

Collecting Data

Pamela Y. Abner, MPA, Vice President and Chief Administrative Officer, Office for Diversity and Inclusion, spearheaded the effort to make it a standard procedure across most of the Health System to collect data in Mount Sinai’s patient registration systems on race, ethnicity, language, and sexual orientation and gender identity. The data are available to clinicians and researchers to enhance patient care and further study on an innovative Disparities Dashboard, created with leaders including Dr. Richardson and Nina A. Bickell, MD, MPH, Professor of Population Health Science and Policy, and Medicine.

“In the case of COVID-19, it appears that African-American patients were coming into the hospital sicker,” says Ms. Abner, citing preliminary findings. “We will now be able to analyze our data to determine if there are socioeconomic factors that impact outcomes within our most vulnerable populations. For example, we might look at the relationship between race/ethnicity and those who were more acutely ill, based on ICU numbers or length of stay, and consider how that may have impacted clinical outcomes.”

Dr. Richardson has experienced the toll of the COVID-19 pandemic more directly than most. In addition to her administrative and research duties, she treats patients in the Emergency Department at The Mount Sinai Hospital and at Elmhurst Hospital, and recently recovered from COVID-19 herself. “Now that we have come through the worst of the COVID-19 pandemic, it is important that we thoroughly investigate all of the causes of its disproportionate impact on racial/ethnic minorities and vulnerable communities, which are layered on top of many longstanding, pre-existing health and health care disparities,” Dr. Richardson says.

The overarching goal is addressing needs of populations at risk of COVID-19 and other health issues, which includes many members of the Mount Sinai community. “Mount Sinai is the biggest employer in East Harlem,” Dr. Horowitz says. “These are the people who are delivering food, delivering medicine, driving people around, working as home attendants. These are heroes; these are the people who have not stopped. They are not staying home in isolation, because they can’t.”

“At this point, our ability to understand, partner with, and serve those who are most vulnerable to COVID-19 is a reflection of our commitment as human beings, as researchers, as clinicians and as a Health System,” Dr. Horowitz says. “We are only as good as how we care for our most vulnerable populations.”

Read more about Mount Sinai and the community.

How a Mount Sinai Program Is Helping Survivors of Sexual Assault and Intimate Partner Violence

May 13, 2020 | COVID-19, Featured, Public Health

In the midst of the COVID-19 pandemic, a very different health crisis is continuing unabated—sexual assault and intimate partner violence (IPV). An experienced and compassionate team at Mount Sinai is there to help.

“It’s been a little bit challenging, but we do not want to let that stop us from providing very critical services,” says Angela Fernandez, Assistant Director at the Sexual Assault and Violence Intervention (SAVI) Program, a team that includes physicians, social workers, and advocates. “We’re still operational.”

Founded in 1984, SAVI has offered free services and support to survivors in New York City for more than thirty years. Its most visible program trains 100 people a year to provide emotional first aid and bedside advocacy to survivors in emergency rooms throughout Manhattan, Brooklyn, and Queens. Volunteers undergo a 40-hour New York State Department of Health training and—following medical, background, and health screenings—commit to bimonthly, six-hour shifts in which they are on-call to be deployed when a participating emergency department has identified an instance of sexual assault or intimate partner violence. The volunteers are equipped to facilitate communication with law enforcement, counsel survivors on their rights, and help them identify and acquire basic needs like shelter. Ms. Fernandez sees advocates as a temporary best friend who can help survivors to navigate any uncertainty faced while in the emergency room.

This intimate, peer-to-peer service has been complicated by COVID-19, since in an abundance of caution, emergency rooms are barring most visitors. Fortunately, the Department of Health has mandated that all survivors are entitled to an advocate. SAVI began offering phone advocacy in mid-March to continue to provide this essential service while adhering to safety measures. Through phone advocacy, survivors can speak with an advocate—via a hospital line or their own mobile phone—to receive support, advice, and assistance.

“Our volunteers are still there. We are still responding to the need, albeit from a distance,” says Ms. Fernandez.

Fewer Domestic Violence Calls, but Not Necessarily Fewer Assaults

In early April, weeks after the “New York State Pause” closed most businesses and imposed social distancing, the New York Police Department released statistics showing a downward trajectory in crimes. For the month of March, domestic violence calls were down 15.3 percent.

“Sexual violence and intimate-partner violence was already grossly under-reported,” says Ms. Fernandez, who cautions that this downward trend does not mean that fewer assaults are being committed. “The fact that we are not seeing as many people making a police report is not surprising, because it’s already something that not a lot of people do.”

Additionally, survivors are not immune to troubling news reports about the pandemic. For a survivor, fear of contracting the virus when going to an emergency room may outweigh the need to seek help. This is particularly relevant for IPV survivors who, Ms. Fernandez notes, often do not seek medical care for the abuse itself but from underlying health conditions associated with abuse and trauma.

“It is in the middle of treating someone for a chronic stomach issue, an asthma attack, or a headache that will not go away in which it is disclosed that abuse is happening at home,” she says. “If a survivor knows that these symptoms cannot possibly be the virus, they may think—my issue isn’t serious enough.”

In fact, abusers may use the stay-at-home order, as well as the economic crisis caused by COVID-19, to further isolate survivors, forcing them to determine whether their home life is more or less threatening than potential exposure to the virus.

“It’s coming down to basic needs for many survivors, and an abusive person can exploit the situation, especially if they have food, shelter, and are even willing to pay someone’s phone bill,” says Ms. Fernandez.

SAVI employs licensed clinical social workers and mental health counselors who provide confidential, trauma-informed therapy to survivors who have left abusive situations as well as those currently in abusive situations. This service has largely shifted to HIPAA compliant virtual sessions—completed via phone or videoconferencing—although in-person sessions are available for emergency, high-risk cases.

“For some, the discussion is not about the abuse, it’s about survival. So many people have had to return to abusive situations, because they didn’t have anywhere else to go. Survivors are having to make really, really hard choices.”

Programs like SAVI hope to make these choices less daunting. Through phone advocacy, virtual counseling sessions, and ad-hoc in-person meetings, survivors can receive advice, assistance, and support from an experienced team dedicated to their physical and emotional safety.

“Survivors are very resilient,” says Ms. Fernandez. “This might not be the best time to make big decisions—like leaving an abuser. We understand that survivors know their situation best, and we are there for them every step of the way.”

If you or a loved one needs advice, assistance, or support regarding sexual assault or intimate partner violence; the Sexual Assault and Violence Intervention (SAVI) Program at Mount Sinai is available to help. For more information, visit the SAVI website or call 212-423-2140. 

Learn more about SAVI

Pin It on Pinterest